Claim total
$123.26
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2009-11-10
- Stop
- 2009-11-10
The parties
- Patient
- patient Jared Lenard Hansen
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Anthem
Record id
047ee4ec-c50b-b504-c7a3-a3e169bbc782